Medical waste is extremely hazardous to the environment and human health. In developing countries like Bangladesh, pollution from medical wastes due to unplanned hospitals and clinics resulting from urbanization has become a serious threat to the environment and public health. This situation is made serious due to poor management of medical waste and gross mismanagement in the sector. As a result, doctors, nurses, ward boys, lab technicians, cleaners and common visitors are suffering from various types of serious diseases and these pollutions are also spreading alarmingly in soil, water and air.
In fact any type of waste, if there is a possibility or fear of infection from it, is called medical waste i.e. any type of waste related to medical care such as doctor’s offices, hospitals, medical research areas in laboratories, dentists’ chambers, blood banks, nursing homes for the elderly and animal medical waste is everything that is generated from hospitals. The World Health Organization (WHO) has classified medical waste into two main categories. First is general healthcare waste which is non-infectious material such as animal tissue, office paper, sweepable waste, kitchen waste etc. Second, hazardous medical waste such as needles, knives, scissors, blades and human tissues, fluids and any objects with potential for infection.
According to the definition of ‘Medical Waste Tracking Act’ of 1988, any waste generated during medical research, testing, diagnosis, administration of vaccines or treatment of humans and animals is called medical waste e.g. cultured dishes, any glassware, gauze, bandages, cotton, masks, gloves, discarded knives and scissors, needles, saline bags, blood bags, collected saliva, sputum samples, body fluids, tissues, tumors, human organs etc. Although medical waste is called by many different names, the basic content of all of them is the same, i.e. these substances generated during the delivery of medical care increase the possibility of infection.
Toxic substances, harmful metals and chemicals are constantly released from these medical wastes and it is constantly mixing with soil, water and air. Since there is no proper direction for the management of these wastes from the Department of Environment, it is being managed like normal waste. Medical waste is definitely identified as a major cause of public health and environmental disaster. The range of medical facilities in Bangladesh has increased to a great extent, along with the use of disposable medical supplies.
A huge amount of medical waste is generated every day. Most of these wastes are carriers of more or less infectious organisms. But unfortunately, the position of Bangladesh is very fragile considering the standards of waste management generated in the medical field.
According to WHO guidelines, every hospital design should specify a safe disposal system for medical waste. Most hospitals around the world have medical incinerators and autoclaves for medical waste management. Apart from this, liquid waste management has modern equipment including a liquid treatment plant. But our country’s hospitals are still not able to achieve world class waste management. The management of medical waste in Bangladesh is handled by the city corporation and there is no specific policy so the waste is managed through the process, which is very risky for public health.
Recently, Transparency International Bangladesh (TIB) in a research report on the public health risk of medical waste titled ‘Challenges of Good Governance in Medical Waste Management and Ways of Passage’ mentioned that hospital waste is being sold outside a cycle without sterilization which is again in various hands taking place in various drug stores, hospitals and clinics. According to the research report, there are two types of hospital medical waste that are sold illegally, reusable waste and recyclable waste.
A syndicate of hospital staff sells the recyclable waste such as used glass bottles, syringes, saline bags and rubber/plastic tubes to the recyclable waste collector without waste. Later, through this syndicate, the reusable waste is cleaned and packaged without proper sterilization and sold to drug stores, various hospitals and clinics. These materials are not properly sterilized. As a result, reuse of these materials carries the risk of serious infectious diseases including HIV. Similarly, the syndicate sells recyclable medical waste (used syringes, blades, knives, scissors, blood bags and tubes, metal instruments, etc.) to junk shops and recycling factories without destroying them in contaminated condition.
As a result of transporting these wastes in an infected state, the associated workers and the workers of recycling factories are affected by various infectious diseases and the risk of environmental pollution increases. The TIB has received complaints against officials of various hospitals in a district for illegally selling around 3,500 kg of plastic medical waste per day.
The research report also mentions that there is a lack of compliance in hospitals even though there are guidelines for the use of color codes in waste storage containers and the use of symbols approved by the WHO. Overall 29 percent of hospital waste storage containers are not color coded and 51 percent containers are not marked. Also, COVID-19 and general medical waste are collected and stored together. According to the Medical Waste Rules-2008, there is a lack of compliance despite the directives to cut rubber/plastic tubes and various bags used to prevent re-use of medical waste. Overall 28 percent of hospital used rubber/plastic bags are not shredded and 31 percent of hospital used rubber/plastic tubes are not shredded. Guidelines require that needles used in healthcare facilities be destroyed or melted down immediately after use to prevent reuse. It can be seen that 49 percent of hospitals do not have needle destroyers.
Moreover, there are allegations of illegal trade of waste against the contractor. They sell the waste on the black market without wasting it. TIB has received allegations of illegal trading of plastic medical waste in the black market against a well-known contracting firm.
TIB says there is a lack of capacity building in addition to a lack of transparency and coordination in waste management. Irregularities, corruption, sale of waste without disposal through syndicates without sterilization have created massive health risks. On the other hand, in the past two or three years, the increase in infections due to the Corona epidemic, the increase in the use of surgical masks to protect against infection and the throwing of masks after use and the disposal of vaccines and the throwing of used needles have greatly increased the risk of public health and environmental pollution. Public health experts say that it is important to take appropriate steps by the authorities concerned to get rid of it.